{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"EDITH L BENTON","gend":1,"add":"1207 CARRSVILLE HIGHWAY","city":"FRANKLIN","state":"VA","zip":"23851-3963","dob":"1955-05-18","age":"","mstatus":"","insh":"11006780","cliId":"","pno":4345948169,"cno":"","email":"","ename":"","eno":"","pphy":"COLEMAN, GEORGE C","ppno":8048348871,"pcpadd":"344 W Main St","pcpcity":"Waverly","pcpstate":"VA","pcpzip":238903235,"pcpcounty":"","pcpid":"","pcpname":"WAVERLY MEDICAL CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"APT 14A","add3":"","madd1":"1207 CARRSVILLE HIGHWAY","madd2":"APT 14A","madd3":"","mcity":"FRANKLIN","mstate":"VA","mzip":"23851-3963","pcpfaxno":"(804) 834-8875","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":[]}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","00093585105","ESCITALOPRAM ","10MG","30.00","Select","Select",""],["","00186504054","NEXIUM ","40MG","30.00","Select","Select",""],["","65162047810","NITROFURANTN ","100MG","14.00","Select","Select",""],["","16729017317","AMITRIPTYLIN ","50MG","60.00","Select","Select",""],["","29300011716","TOPIRAMATE ","100MG","60.00","Select","Select",""],["","68645051654","AMLODIPINE ","10MG","30.00","Select","Select",""],["","59746000103","METHYLPRED ","4MG","21.00","Select","Select",""],["","16571020210","DICLOFENAC ","50MG DR","60.00","Select","Select",""],["","00046087221","PREMARIN ","0.625MG","30.00","Select","Select",""],["","00310737020","BUDES\/FORMOT ","160-4.5","10.20","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","16.00","Select","Select",""],["","29300013005","HYDROCHLOROT ","12.5MG","30.00","Select","Select",""],["","59310057922","PROAIR ","","8.50","Select","Select",""],["","00054001729","PREDNISONE ","10MG","30.00","Select","Select",""],["","29300022019","MONTELUKAST ","10MG","90.00","Select","Select",""],["","16729032115","OLMESA ","20MG","90.00","Select","Select",""],["","00172392770","DIAZEPAM ","10MG","1.00","Select","Select",""],["","31722071390","PANTOPRAZOLE ","40MG","30.00","Select","Select",""],["","72618300002","NURTEC ","75MG ODT","8.00","Select","Select",""],["","00173068220","VENTOLIN ","","18.00","Select","Select",""],["","70010077001","METHOCARBAM ","750MG","15.00","Select","Select",""],["","00115164501","NITROFUR ","100MG","14.00","Select","Select",""],["","65862007701","CIPROFLOXACN ","500MG","14.00","Select","Select",""],["","65862078430","ESOMEPRA ","40MG DR","30.00","Select","Select",""],["","55111014512","FLUCONAZOLE ","150MG","1.00","Select","Select",""],["","00603254421","BUT\/APAP\/CAF ","","12.00","Select","Select",""],["","00186037220","SYMBICORT ","80-4.5","30.60","Select","Select",""],["","68180096301","ALBUTEROL ","HFA","17.00","Select","Select",""],["","00245021211","MIDODRINE ","5MG","90.00","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Review of Systems and Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":"","a13":""}]}]}